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Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
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Dr. Zeljko Reiner,
This debate dealt with two topics. Firstly: Preparticipation screening is more effective than automatic external defibrillators (AED). In his pro statement, D. Corrado from Padova, Italy presented arguments speaking in favour of such an approach based on the scientific evidence. These data suggest that using the Italian protocol for screening, a reduction of incidental sudden death of young competitive athletes of 90% can be obtained. If such screening were applied, the cost of saving a life would be about one million Euros but this would be returned by saving 30-40 years of productive life. He claimed that there is no alternative preventive strategy to such a preparticipation screening. AED has not been very successful so far (only one of 9 athletes was successfully resuscitated).
Dr Capucci from Piacenza, Italy who was speaking contra, claimed that the sensitivity of screening is high but the specificity is low (the USA protocol), there is a lack of standardisation in quality and type of screening, the cost of screening is high and there is a high rate of unrecognized cardiac problems. ECG used in screening has a high % of false negative results and Echo has a high rate of false positive results. Non-cardiac causes of sudden death can not be detected by screening. Although there are still controversies about the use of AED, they have to be available at all athletic events, health and wellness centres. However, early resuscitation may not be as successful as expected since some data suggest that early cardiac massage and AED may induce ventricular fibrillation. The conclusion might be that it may not be a question of choosing between preparticipation screening or AED, but rather that both might be useful.
The second topics was “Genotyping identifies athletes at risk”. R. Brugada Terradellas from Montreal, Canada who was defending the pro position, explained the advantages of genotyping, despite low prevalence of genetic diseases and questionable cost-effectiveness at the moment. Genetic tests are good for disease diagnosis and/or disease confirmation. The advantage is that a genetic test has only has to be done once. G.A. Danieli from Padua, Italy argued against the motion, and claimed that the limitations of genetic testing include its high cost, it is time- and effort-consuming, and genetic heterogeneity is a problem – an unknown number of genes still await identification and at the present time, screening for known mutations is almost useless. DNA chip technology is very effective for screening some mutations, but is unable to detect large deletions. Most newly detected mutations are missense and it is difficult to establish the clinical significance of such mutations. The conclusion might be that genotyping could be useful in athletes with a history of syncope or sudden death in the family but negative results cannot exclude the risk.
Strategies to prevent sudden death in athletes
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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